GLUTEN – ALL THE TALK THESE DAYS

CELIAC DISEASE

Celiac disease (gluten-sensitive enteropathy) is an autoimmune disease of intestinal damage due to gluten in people who are genetically predisposed. Classic Celiac disease is diagnosed by abnormal blood tests and an abnormal appearing intestine on biopsy and symptoms that resolve with a gluten-free diet.

Several blood tests exist for Celiac disease but they have varying degrees of accuracy as some are more sensitive yielding positive in milder form of the disease. Although, a positive result from some tests may not indicate Celiac disease. Others are very specific as their positive result shows the existence of the disease. The most specific tests for Celiac disease are endomysial antibodies (EMA) and tissue transglutaminase antibody (tTG )tests.

These two tests are lgA based tests and can be negative if you are deficient in the immunoglobin lgA, which occurs in 10-20% of people with Celiac. When either EMA or tTG is positive, Celiac disease is very likely and usually, the intestine biopsy is positive. Recent studies indicate that the tTG may only be positive in 40% of true Celiacs when mild degrees of intestine damage is present on biopsy. Seronegative Celiac, meaning the blood tests fire negative but the biopsy is positive, may occur in up to 20% of Celiacs.

Antibodies for gliadin {AGA}, the toxic fraction ot gluten are considered very sensitive but not specific for the Celiac disease. Newer assays for AGA antitbodies for gluten that has undergone a chemical change called deamination appear to be more specific for Celiac disease (Gliadin ll, lnova) than the older gliadin tests. They also may be as or more accurate than EMA and tTG antibody tests but are not yet widely available.

The most distressing problem for people with lesser forms of gluten intolerance who have blood tests and/or biopsies that are normal or borderline yet respond to a gluten-free diet is either not being taken seriously or knowing for sure if they are sensitive to gluten. For these individuals, stool antibody testing for antigliadin and tTG have been helpful. Such stool testing has been performed in research labs and published in a few studies.

A celiac sufferer is someone who experiences serious physical and emotional reactions when they eat foods containing gluten. Their bodies cannot tolerate gluten and never will. The only known celiac disease treatment is a celiac disease diet, a lifetime diet that is free of gluten. Celiac disease treatment simply means following a diet that avoids food products that contain gluten.

GLUTEN

Gluten is a protein composite found in wheat and other related grain species like spelled, kamut, and triticale including barley and rye. This implies that it can be found in any foods processed from these grains, or near these grains. The word “gluten” comes from the Latin for “glue”. Gluten gives elasticity to dough, helping it to rise, keep the shape, and can give the final product a chewy texture. As it is used as a thickener, gluten can be found in soups and broths, gravies, salad dressings, mayonnaise. It is added to the strangest and seemingly unlikely places such as yogurts, as it makes it smoother, creamier and so-called “more palatable” food.

Gluten is also often found in the substance used to seal envelopes since it acts as a stabilizer. Gluten is used to create protein supplements and create substitutes (such as seitan), for people (such as vegetarians or vegans who do not get enough protein in the diet.

There are various food options on a celiac disease diet with many foods naturally gluten-free, which includes fresh meat, chicken, fish, eggs, cheese, milk, cream, butter, all fresh fruits, salads, vegetables, potatoes, rice and maize, nuts and seeds, jam, marmalade, honey, some brands of chocolate, some brands of ice cream, sugar, sunflower oil and olive oil. The emphasis on the word “fresh” is important.

Food products that contain gluten are made from wheat, rye, barley and traces of them, ruling out all ordinary breads, cakes, pastas, breakfast cereals, pies, French fries, gravies, seafood, matzo, salad dressings, processed luncheon meats. croutons pastries, donuts, cookies, malt vinegar, soy sauce, mustard and mayonnaise, some tinned soups and sauces, potato chips, pretzels and similar snacks, mixed vegetable oil can contain wheat-germ oil, many candies, many ice creams, and many convenience foods. It is necessary to understand that wheat must be eliminated from the diet, but wheat is hidden behind a lot of other titles, such as bulgur, durum flour, farina, graham flour, kamut, semolina and spelled. It is important that you understand that gluten is “hidden” in many processed foods, such as pre-prepared meals, cereal, frozen French fried potatoes, snacks, and sauces such as mayonnaise, mustard, and soy sauce. Oats are controversial. Very often oats are grown in a field next to a field planted with wheat. There is enough contamination there to cause severe reactions in some people. Oats and wheat are often processed in the same facilities.

Even many non-food items like cosmetics, vitamins and household cleaners contain gluten. It is best to seek professional advice from a dietician or nutrition specialist to compile a list of all foods and products that must be avoided. Other than these, celiac food consists of much of what everyone else eats.

Fortunately, a celiac disease sufferer will be able to carry on drinking many of his/her favorite drinks as before (prior to diagnosis of the disease). The big exception is beer. Almost all beer is brewed with malted barley or wheat and so will contain gluten. Spirits made without any grain such as brandy, wine, mead, cider, sherry, port, rum, tequila, and vermouth do not contain gluten. Although straight Bourbon is made from corn and wheat, rye or barley, the gluten in these grains is removed by the process of distillation.

Whiskey will likely contain gluten as the malted barley or rye is often added after the grain mash has been distilled. And, the labels on liqueurs and pre-mixed drinks should be examined carefully for glutinous ingredients.

Nonalcoholic drinks that are gluten-free to consume are coffee, tea, fruit drinks, cocoa, and many carbonated drinks. You must read the labels carefully. A celiac disease diet need not be boring. People on a celiac disease diet still eat many of the foods they ate before they were diagnosed, but they replace some ingredients with gluten content with ingredients that are gluten-free. To keep diversity in their diet, people on a celiac disease diet can still enjoy bread and pasta made out of potato, rice, soy, or bean floor. Today, it is easier since there are manufacturers who sell gluten-free bread, pasta, and other food.

Also, there is a plentiful supply of gluten-free recipe books that can be purchased online. Finally, there are celiac disease support groups in every state in the USA. One of the benefits offered by these groups is a sharing of so many gluten-free recipes.

A boring celiac disease diet is down to a boring and perhaps lazy cook. It need not be that way. With 2 million celiac sufferers in the United States, you can’t afford to remain ignorant about the disease and its only known treatment, a celiac disease diet.

Reading food labels is an absolute must, but even reading labels with utmost care will not always give the answers one needs. Labels are confusing. Different countries label differently. The US FDA allows 4 times the accepted amount of gluten to be considered “gluten-free” as Australia; large difference. The celiac sufferer needs to learn how to carefully read the labels on processed foods because glutinous traces are often found in them. Make sure that the food you will be picking up from the supermarket shelves is celiac food. Fortunately, there are products today which are glutenfree. Most doctors recommend avoiding oats entirely unless they are labeled specifically “gluten-free. ”

Gluten intolerance is a term used to describe three conditions: wheat allergy, non-celiac gluten sensitivity, and celiac disease. All three conditions are difficult to diagnose, so many people are unaware that this intolerance is at the root of other health issues.

Most forms of gluten intolerance cause the body to produce an abnormal immune response in the presence of wheat or its proteins. An allergy to wheat can produce symptoms such as hives, difficulty breathing and digestive problems. ln really serious cases, a person with this allergy can experience anaphylaxis. With celiac disease, which causes damage and inflammation in the small intestine, people may suffer from bloating, weight loss, fatigue, and headaches, as the body cannot obtain all the nutrients it needs from food. Non-celiac gluten sensitivity is even harder to diagnose, so most often these people are lumped into the celiac category.

Starting on a gluten-free diet, one must make certain to attain enough fiber, folate, iron, niacin, riboflavin, selenium and thiamine; often lacking in a gluten-free diet. Additionally, it is important to not fill up on too many simple carbohydrates. Too many refined flours like white rice flour would not be a healthy start.

CROSS-CONTAMINATION

Cross-contamination occurs when gluten-free foods come in contact with foods containing gluten. This can occur so easily and in unthought-of ways just in the home. Wooden cutting boards or utensils that have been used with a gluten-containing food must not be used when preparing something gluten-free. Using a toaster that has been used for wheat bread is a major source of contamination. Any non-wooden utensils must be thoroughly cleaned before using to prepare a gluten-free food. If one uses wheat flour in a recipe, it can take up to 24 hours for the wheat dust particles in the air to completely settle. Or, using butter that someone else has swiped to butter a slice of wheat bread, leaving behind traces of that bread.

Cross-contamination occurs in processing facilities when gluten-free foods come in contact with foods containing gluten, such as when using the same equipment to make a variety of products. Some foods are labeled “may contain” but understand that this labeling is voluntary. Check the ingredient list. If you aren’t sure if a food contains gluten, either don’t buy it or call the manufacturer to ask what it contains.

When initially eliminating all the gluten-filled products from the diet, one can experience mild to severe withdrawal symptoms. Gluten’s complex proteins trigger the body to manufacture chemicals similar to endorphins, producing a calm and relaxed feeling. Just as when an opiate consumption is stopped, one can experience a degree of withdrawal from gluten. This withdrawal can cause irritability and intense cravings. Additionally, the body heals during the first week or so of going gluten-free other possible side effects could be things like hives, mild rashes or headaches. This is because of the body, and particularly the liver, as it is in the process of detox, can suddenly better process and eliminate toxins. Understand this is a process and will pass. Switching to a gluten-free diet is a huge change, and as with anything new, it requires getting used to all these new concepts. While one may initially feel deprived by all the restrictions, it may come as a pleasant surprise to find how many gluten-free products are available. Above all, stay positive.